Membership

Member Registration

Fields marked with a * are required

First Name *

Last Name *

Address 1 *

Address 2

City *

State *

Zip / Post Code *

Home Phone *

Cell Phone

Work Phone

Email *

License Type(#)/Certificate

Membership Type *

If this is your first time registering with the MLCPCA, you will receive a $20 discount (except student members). Once you submit this information, you are registered with the MLCPCA and will be directed to the payment page where you will choose the membership option that is best for you. You will be able to complete your payment there.